ARTICLES

 

The effects of a father's alcohol misuse on the wellbeing of his family: views of social workers

 

 

Ms Janelle Kühn^I; Dr Ilze Slabbert^II

^IPostgraduate student
^IIDepartment of Social Work, Stellenbosch University, Stellenbosch, South Africa. <islabbert@sun.ac.za>

 

 

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ABSTRACT

Alcohol misuse poses a major threat to the wellbeing of families. If a father drinks excessively, all members of the family are affected. A qualitative study of an exploratory and descriptive nature was undertaken in which 20 social workers were interviewed. The systems theory was used as a theoretical framework. The goal of the study was to explore and describe the effects of alcohol misuse by a father on the wellbeing of his family, as viewed by social workers. Four themes emerged from the findings. Some conclusions and implications are also noted.

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INTRODUCTION

Use of alcohol is legal and it is easily available, but there is a fine line between the responsible use and the abuse of alcohol. Although alcohol is used on many occasions such as celebrations, funerals, religious rituals and recreational activities, and for pain relief, the harmful consequences of the excessive use of alcohol on the wellbeing of families are often overlooked. Alcohol is usually misused to numb pain, to help in forgetting, to be socially accepted, to lose inhibitions, for pleasure and because of peer pressure. Alcohol misuse could be referred to as a maladaptive pattern of drinking, leading to clinically significant impairment or distress, and eventually resulting in a failure to fulfil major obligations at work, school or home. In addition, regular misuse of alcohol could also occur in situations where it would be physically hazardous, for example, driving a car or operating machinery. Alcohol misuse also carries serious risks, such as impairment of health, bolstering a propensity towards criminal activity, and loss of productivity in the workplace, to name but a few (Butcher, Mineka & Hooley, 2010; Clark, 2002).

Although some scholars (Fisher & Harrison, 2013; Stephens & Smith, 2013) distinguish between alcohol abuse and misuse, most authors (Hutchinson, Mattick, Braunstein, Maloney & Wilson, 2014; McCarthy & Galvani, 2012; Zohhadi, 2006) agree that these can be regarded as equivalent when indicating irresponsible use of alcohol resulting in alcohol use disorder (AUD). AUD is regarded as a chronic disease that develops gradually with regular alcohol misuse. To be diagnosed with AUD, individuals must present certain indications outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Eleven indications are listed and any person meeting any two of these during a 12-month period is diagnosed as having AUD. Indications include persistent desire or unsuccessful attempts to cut down on alcohol use; alcohol being taken in ever increasing amounts and over a longer period than was initially planned; and cravings or a strong urge to use alcohol. The severity of an AUD ranges from mild, moderate or severe, depending on the number of indications displayed (APA, 2013). For the purposes of this study the terms a father's alcohol abuse, alcohol misuse and AUD will all refer to the irresponsible use of alcohol and its negative effects on the wellbeing of the family.

Alcohol misuse is generally associated with the failure to control one's behaviour after consuming excessive amounts of alcohol. The short-term effects that have been identified include socially inappropriate behaviour such as loose talk, including the use of vulgar and foul language with disregard for social norms, and urinating and defecating in one's clothes. Vomiting, undressing in public, domestic violence, failure to meet domestic and work obligations, failure to take care of one's physical needs, including an aversion to food, and an inability to know when to stop drinking are other possible short-term effects. The long-term effects emanating from excessive alcohol intake include loss of respect from the family and the rest of the community, who view the alcohol abuser as a disgrace, as well as accompanying health complications. The most serious long-term effect of AUD, however, is the detrimental effect it has on the wellbeing of families, as will be discussed below (Kafuko & Bukuluki, 2008; Klingemann, 2001).

Social workers in South Africa often have to deal with the devastating effects of alcohol misuse not only on the user, but also on the family system and subsystems (Koopman, Parry, Meyers & Reagon, 2008). The Integrated Service Delivery Model (Department of Social Development, 2006) identified the following core services that are rendered to clients: promotion and prevention services, rehabilitation services, protection services, continuing care services, and mental health and addiction services. All of these could be relevant to families where there is a father who misuses alcohol. Although other family members could also misuse alcohol, this study will focus on the father figure who misuses alcohol.

 

EFFECTS OF ALCOHOL MISUSE ON FAMILY WELLBEING

The family systems theory was chosen as the theoretical framework for this study. According to the theory, every family member influences the others in predictable and recurring ways. The theory attempts to provide an insight into why members of a family behave the way they do in a given situation. In a family where the father abuses alcohol, it is inevitable that his behaviour will have an effect on other family members and on the family's general wellbeing (Brandell, 2011). According to Goldenberg and Goldenberg (2002), the family system consists of different subsystems, namely the couple, parent-child and the sibling subsystems (Ross & Deverell, 2004). The irresponsible drinking of a father will affect all these subsystems, as will be discussed later.

In a family where a father misuses alcohol, all members experience stress and fears of various kinds. This scenario has often been referred to as a "family illness". Family life might become almost unbearable and members may become traumatised to varying degrees. Different family members every so often experience broad swings along the emotional, psychological and behavioural continuum. Normal routines are also constantly interrupted by an intoxicated father's behaviour (Dayton, 2012; Holtman, Shelmerdine, London & Flisher, 2011). The father's alcohol misuse induces fear in the family members and stress, because they can never predict his behaviour. Research indicates a high probability of the father or male partner being the irresponsible drinker, although mothers, female partners and children could also misuse alcohol (Schiff, 2004; Werner & Malterud, 2016).

According to Kafuko and Bukuluki (2008), harm to personal finances, poor health and loss of relationships are but some of the consequences of alcohol misuse, the most important being psychological harm and emotional turmoil inflicted on others, and the consequent breakdown of relationships. Fisher and Harrison (2013) note that family members often have to cope with the confusing unpredictability and frequent unpleasantness of life with the father who abuses alcohol. The more serious an alcohol problem, the less able the inebriated father is to perform competently, or to fulfil all the various roles and responsibilities expected of him as a partner and parent. It is clear that the excessive drinking of a father has serious consequences for the different subsystems in the family.

 

CONSEQUENCES OF ALCOHOL MISUSE For SUBSYSTEMS IN THE FAMILY

As noted above, a family member's behaviour will have an effect on other family members. The consequences of a father's misuse of alcohol on the couple, parent-child, and sibling subsystems respectively will be presented.

Consequences of alcohol misuse for the couple subsystem

The couple subsystem is subjected to high levels of stress and tension when excessive drinking manifests. Attempts to manage the drinking often result in dysfunctional behaviour. In the couple subsystem the female partner often attempts to maintain the homeostasis of the family system by covering up for her partner's maladaptive drinking behaviour. This is referred to as co-dependency, where a partner develops unhealthy patterns, trying to deal with the drinking of her companion (Fisher & Harrison, 2013; Schiff, 2004).

Couple conflict may assume a violent form and there is much evidence that domestic violence often, though not always, attends alcohol misuse. A large proportion of perpetrators of domestic violence are either abusing alcohol, or they are under the influence of alcohol at the time of the assault (Stuart, McGeary, Shorey, Knopik, Beaucage & Temple 2014). Stover, Easton and McMohan (2013) found that in approximately half of cases of men entering substance abuse treatment, concurrent intimate partner violence (IPV) was reported.

Consequences of alcohol misuse for the parent-child subsystem

As reported by Fisher and Harrison (2013) and Klingemann (2001), the father who drinks too much is likely to become unpredictable and disruptive, restricting the family's capacity to plan activities or to stick to familiar routines. The father who misuses alcohol might become unwilling or unable to participate in family events and other members would rather withdraw from family gatherings than risk possible embarrassment should the father be intoxicated.

Several authors (Brandell, 2011; Dayton, 2012; Stephens & Smith, 2013; Zohhadi, 2006) agree that excessive drinking can impair functioning as a parent, as a partner and as a contributor to a family's wellbeing. Excessive drinking requires time, thus impinging on the time needed to deal with family responsibilities and for spending quality time with children. Alcohol misuse, according to McCarthy and Galvani (2012), has a negative effect on parenting, leading to disorganised behaviour, such as placing family members second and making alcohol a first priority. Fathers who misuse alcohol also often have mood swings and squander the family's money on alcohol with scant regard for the daily needs of his family. Inadequate parenting also frequently results in overly strict behaviour or withdrawal from parental duties.

Most obviously, as AUD tends to dominate the lives of everyone in the family, the non-drinking parent may have less time, energy and resources to devote to the children. The non-drinking parent may have to assume complete responsibility for the children, and may well have to share with the children the realities that, for instance, they cannot invite friends over or that there is not enough money available to meet their needs. This scenario will, of course, be more complicated if more than one family member - for instance, both parents - misuses alcohol (Butcher et al., 2010).

Consequences of alcohol misuse for the sibling subsystem

Closely related to the parent-child subsystem is the sibling subsystem. McCarthy and Galvani (2012) emphasise the importance of trust in a child's life. Trust within a family is viewed as a prerequisite for the development of healthy personalities. Children's wellbeing depend greatly on the trust and love of the adults and parents who care for them. They also need to be able to establish trust in the fact that the parents will continue to be present in an effective manner in future to meet their needs. The children in an alcohol-abusing family may experience various forms of neglect and feel abandoned by both parents. They might harbour wishes that their father would die or that their mother would simply leave the relationship. Often these children have limited or completely restricted capacity to initiate or sustain friendships and other relationships, and could fall victim to verbal, sexual or physical abuse. They might also be witnesses to conflicts, perhaps violent clashes, between their parents, and often experience the break-up of the family (Hooper, Doehler, Jankowski & Tumek, 2012).

A father who drinks heavily at home, burdens his family with extra responsibilities and his children might fear or detest him. They might try to avoid him rather than face conflict. This may contribute to poor scholastic performance by the children and induce a negative attitude towards both the father and the mother (Kafuko & Bukuluki, 2008). Another phenomenon that often occurs in the sibling subsystem is parentification. According to the family systems theory, parentification is the process where children take on the adult roles and responsibilities that parents neglect. This usually happens where boundaries are loose or non-existent, as in families where the father drinks excessively (Hooper et al., 2012).

It is estimated that approximately 25% of children are affected by alcohol misuse in the family. These children are more likely to experience increased family hostility, poor parenting and insufficient monitoring, affecting the child's performance in school (Coyle, Nochajski, Maguin, Safyer, DeWit & McDonald, 2009). Children are the most severely affected, since they can do little to protect themselves from the direct or indirect consequences of a parent's abuse of alcohol (Klingemann, 2001). Another negative impact of alcohol misuse concerns children's identity development (Klingemann, 2001; Zohhadi, 2006), in that the father distances himself both physically and emotionally from his family and society.

In the light of the above, it seems that alcohol misuse, specifically by the father figure, poses serious challenges to society as well as to families involved. To meet these challenges families need guidance from professionals such as social workers. This need provided the motivation for this paper, which is aimed at answering the research question: "What are the effects of alcohol misuse by a father on the wellbeing of his family as viewed by social workers?"

 

METHOD

The goal of this study was to explore and describe the effects of alcohol misuse by a father on the wellbeing of his family, as experienced by social workers. A qualitative study was used, because qualitative research focuses on describing and understanding rather than explaining or predicting human behaviour or naturalistic observations (De Vos, Strydom, Fouché & Delport, 2011). The research design was explorative and descriptive in nature in order to obtain the views of social workers on the effects of a father's excessive drinking on the wellbeing of families (Babbie, 2010; De Vos et al., 2011).

To obtain the views of social workers, a purposive sample of 20 social workers who render services to families affected by alcohol misuse in the Western Cape was selected. The criteria for selecting participants were that they had to have more than two years' work experience and specifically also in the field of substance abuse (De Vos et al., 2011).

Data were collected by means of a semi-structured interview guide. A pilot study was also executed to determine whether the interview guide was appropriate. Ethical clearance was obtained for this study. Interviews were audiotaped with the permission of the participants and transcribed. The data were analysed and categorised into themes and sub-themes (Creswell, 2007). Some limitations for this study were also noted, namely that it was a qualitative study and conducted only in the Western Cape; the findings could therefore not be generalised. The study was focused only on social workers' views on fathers who misused alcohol. The impact on the wellbeing of families where both parents, or only the mother, misuses alcohol was not investigated in this study (De Vos et al., 2011).

 

DISCUSSION OF FINDINGS

The following section will focus on the presentation and analysis of the findings of the study, which are presented in a narrative style in order to explore the views of social workers on the effects of a father's alcohol misuse on the wellbeing of his family.

Four themes were derived from the data as displayed in Table 1.

 

THEME 1: CONSEQUENCES OF ALCOHOL MISUSE FOR THE WELLBEING OF FAMILIES

Generally, hazardous drinking leads to severe changes in the family setup, which becomes stressful and demanding. The father often fails to fulfil family obligations and other members struggle to maintain the homeostasis in the family. The mother may have to be the only breadwinner and fulfil all parental duties. Children in these families frequently struggle to cope with responsibilities such as caring for younger siblings. The overall wellbeing of the family where alcohol is misused is thus at risk when a father is misusing alcohol (Fisher & Harrison, 2013; Wagman, Donta, Ritter, Naik & Nair, 2016). Two sub-themes emerged from this theme and are presented below.

Sub-theme 1.1: Changes in family functioning

When a family can no longer deal with their problems and basic security, or physical and effective emotional support, cannot be provided for its members, the family system suffers detrimental changes to its wellbeing. Many aspects might negatively affect the wellbeing of a family such as AUD and resultant domestic violence (Guez & Allen, 2000).

Participants' responses regarding changes in the family showed that families become dysfunctional.

"So I think that if the alcohol abuse is on a regular basis … the family becomes dysfunctional, because there is a father figure that is not present."

"Dysfunctional families are often a result where a father drinks too much. One often sees how the whole family disintegrates. It is just too much for them to deal with all the stress of alcohol abuse."

Findings also indicated that families do not function as a unit.

"They don't function as a whole, because your first aspect should be communication. Mom and dad hardly speak and the kids suffer. So there is not a functionality as a whole."

From the abovementioned narratives it is clear that where harmful drinking is present, the family members experience stressful changes in their functioning. This supports research (Brandell, 2011; Fisher & Harrison, 2013; Kafuko & Bukuluki, 2008) indicating that the wellbeing of family members where alcohol is misused is negatively affected. The uncertain behaviour of the father who drinks excessively in certain situations is often very difficult to cope with. Furthermore, Wagman et al. (2016) argue that a father's alcohol abuse increases stress levels and has serious implications for the general health and wellbeing of his family.

Subtheme 1.2: Decrease in income

Alcohol misuse often leads to a downward spiral into poverty in which the drinking behaviour erodes income capacity (through absenteeism, lack of motivation, poor quality of work, loss of employment), while any money earned is spent on alcohol, leaving a shortfall for life's necessities. Reduced earnings or even unemployment is thus a frequent consequence of excessive drinking, and this affects the other family members. Holidays are ruled out, it may become impossible for children to attend school outings, and rent cannot be paid (Brandell, 2011).

The participants were asked to share their views on how drinking affects the family's income. Almost all the participants indicated that financial problems are endemic in families where there is excessive drinking as illustrated by the following comments.

"…because most probably fathers ... especially those who are earning wages ... drink alcohol with all the money and at the end they don't get food or the things that they need or want."

"Less money, less structure, less discipline, then … kids don't have someone to look up to and respect, it is okay if my father drinks, and it is okay if my mother drinks and if it is okay that mother drinks then it is okay if all drink."

"Ok, well I would definitely say financially, especially and I am again referring to the rural areas … alcohol becomes their number one priority for the parents and for the fathers in this case, the father takes the grant and that goes to alcohol and becomes their priority, so financially…"

"Financial strain and violence add to other dynamics within the family."

Several authors (Brandell, 2011; Fisher & Harrison, 2013; Hutchison et al., 2014; Kafuko and Bukuluki, 2008) indicate the financial strain that families experience where alcohol is used excessively. It has been established that financial problems arise when money for food and other necessities is spent on alcohol. Chronister (2007) confirms that such families face huge challenges in making a living.

 

THEME 2: CONSEQUENCES OF ALCOHOL MISUSE FOR THE COUPLE SUBSYSTEM

In theme 2 the effect and influence of the father's drinking on the couple's wellbeing will be explored. Two sub-themes emerged, namely, conflict and divorce/separation. The responses highlighting these sub-themes are discussed below.

Sub-theme 2.1: Couple conflict

Alcohol misuse usually leads to conflict in the couple subsystem and could also turn violent; there is much evidence that domestic violence and alcohol misuse are often related (Fisher & Harrison, 2013). All the participants indicated that conflict between couples was inevitable when a father misuses alcohol. According to them, conflict directly relates to the quality of the relationships.

"This can cause serious problems within the marriage and alcohol abuse influences a person's normal thinking and influences communication between couples."

Some participants reported that conflict also give rise to co-dependency.

"The woman can be very upset, it can be this conspiracy silence thing where she wants to protect him, but in the end the problem escalates. Trying to cover up for him is making the situation worse."

Others stated that the alcohol misuse relates to domestic violence.

"A lot of domestic violence. Where there was domestic violence, alcohol was part of it."

One can conclude from these comments that excessive drinking usually contributes to conflict situations between couples. It is interesting that one participant indicated that women every so often want to protect their drinking partners. It is worth noting that Fisher and Harrison (2013) describe this as co-dependent behaviour, where unhealthy patterns are developed in order to cover up for a father's alcohol misuse. The research (Crane, Schlauch, Hawes, Mandel & Easton, 2014; Klosterman & Chen, 2009) has also indicated that excessive drinking often leads to domestic violence. Although domestic violence can also occur when no drinking is involved, a large proportion of perpetrators are under the influence of alcohol at the time of the assault. Stover et al. (2013) concluded that many men who undergo treatment for their alcohol problem are also apt to abuse their partners.

Sub-theme 2.3: Divorce/separation

Many conditions can lead to the breakdown of relationships. The hazardous drinking of a partner often leads to divorce or separation (Guez & Allen, 2000). Some participants indicated that couples separated because of the father's misuse of alcohol.

"Most of our clients live in a culture where they stay together or they separate, … stay in different households but they don't get divorced legally, but then ja, they do split."

"They live together, but they will … the woman just moves out because of his drinking and goes on with her life…"

Other participants mentioned that affairs, stemming from the excessive drinking, lead to the breakdown of relationships.

"It can also cause divorce, cheating partners, and if I say cheating partners … STDs and HIV can be linked to that."

"Drinking can lead to extra-marital affairs where there is no trust in the relationship that eventually leads to divorce."

Given the unstable relationships arising from alcohol misuse and the accompanying marital dissatisfaction, it is not surprising that separation and divorce are more common in relationships in which at least one partner abuses alcohol. Research indicates that heavy alcohol consumption and frequent drinking episodes are associated with elevated rates of separation and divorce (Hutchinson et al., 2014).

 

THEME 3: CONSEQUENCES OF ALCOHOL MISUSE FOR THE PARENT-CHILD SUBSYSTEM

The parent-child subsystem is severely affected when a father drinks excessively. Parent-child relationships are usually toxic when alcohol is misused. Two sub-themes, neglect, and emotional and physical abuse, emerged under this theme, as discussed below.

Subtheme 3.1: Neglect

Research (Hooper et al., 2012; Werner & Malterud, 2016) indicates that a father's alcohol problems place children at risk of adverse childhood experiences as well as long-term mental health issues. One participant remarked:

"In some families alcohol abuse can lead to neglect, such as physical neglect and in some families it can be more emotional and psychological neglect. In the long run it has serious mental health issues for the kids."

Most participants indicated child neglect as an area of concern.

"Children are neglected and are exposed to the family violence."

"Child neglect or abuse is taking place when a father or parental figure abuses alcohol"

"Uhm... A lot of absent parents, especially if you look at South Africa, parents tend to binge over weekends, which means children have to do stuff on their own on weekends."

"It is especially over weekends when the trouble starts. It is especially if mom also drinks with dad when the kids are often neglected…"

Werner and Malterud (2016) also noted that a significant number of children are neglected in families where alcohol use becomes harmful.

Sub-theme 3.2: Emotional and physical abuse of children

Closely related to sub-theme 3.1 is sub-theme 3.2, dealing with the emotional and physical abuse of children. Children are the most severely affected by alcohol misuse, since they can do little to protect themselves from the direct or indirect consequences of alcohol abuse by a father. Such children, according to Klingemann (2001), are exposed to severe emotional abuse. A significant number of children are also abused physically. Most participants listed the danger of child abuse as highlighted by the following narratives.

"…emotionally for the children and the children are being exposed to this, the drinking and it becomes acceptable and they don't actually know anything else…"

"It is emotionally, because what happens is especially if you look at the boys, they are younger, so I can't beat my dad up, because he is beating my mom, so I become a bully at school and pick on someone younger than me, because I am bigger than him. But I actually want to beat up my dad, because when he is drunk he beats me."

"The children are emotionally neglected and it then has an effect on scholastic levels and the child then rebels and there are much family violence which involves the children."

"Child abuse is common where alcohol is being abused."

It is evident that alcohol misuse by the parent, and in this study specifically by the father, has a detrimental effect on both the physical and emotional development of children. Several authors (Hooper et al., 2012; Koopman et al., 2008; Wagman et al., 2016; Zohhadi, 2006) indicate that there is often a link between alcohol abuse and child abuse. It is worth noting that some children in AUD homes often feel trapped and they do not know who to trust for help, as they do not have their parents to rely on. This constitutes a form of emotional abuse (Werner & Malterud, 2016).

 

THEME 4: CONSEQUENCES OF ALCOHOL MISUSE FOR THE SIBLING SUBSYSTEM

When a father is abusing alcohol, the children in the household tend to suffer greatly. From the responses of the participants, two sub-themes emerged, namely parentification and behavioural problems at school.

Sub-theme 4.1: Parentification

A number of participants mentioned that when a father drinks excessively, the child sometimes has to take on the role of parent as is clear from the following narratives. Participants indicated in the narratives how parentification occurred. Parentification varied from role changes

"I think the roles change within the family..."

"So the family roles definitely change..."

to children becoming the caregivers

"Children take on parenting roles…"

"Children tend to play the role of the caregiver in the home…"

Hooper et al. (2012) found that parentification often occurs in families where there is alcohol misuse and this has a negative effect on children's wellbeing. McCarthy and Galvani (2012) raise another important aspect, namely that of trust. In families where alcohol is misused, trust is often broken (as was also mentioned in sub-theme 3.2). Children must then take over their parents' roles and cannot rely on their parents to help them deal with their own needs and challenges (Hooper et al., 2012; McCarthy & Galvani, 2012).

"Parents are thus letting their kids down and destroy the trust. They deprive the child of his/her rights and fail to provide in the child's needs".

Sub-theme 4.2: Behavioural problems at school

In instances of excessive drinking by the father, the children often start fearing him because intoxication might make him aggressive or withdrawn. This could contribute to poor scholastic performance by the children (Kafuko & Bukuluki, 2008). Some participants mentioned how children in families where there is alcohol misuse struggle to meet scholastic demands.

"I think that they, what I have found with the children that I have interviewed don't go to school or are struggling in school, but the problems are usually not just school-centred but there are problems at school and at home and the problems at home are usually alcohol abuse and domestic violence."

"The children are emotionally neglected and it then has an effect on scholastic levels and the child rebels and there are instances of many domestic violence against children."

Others indicated that children often leave school.

"Sometimes children are abused and they might drop out of school because of alcohol abuse and the home circumstances."

"They don't go to school or don't do their school work and fall out of school."

"… their school grades drop and they might start using drugs and alcohol themselves and then they tend to drop out of school at an early age of ±15 years old".

"Children cannot function at school, fall behind and leave school and that then tends to lead to the child abusing alcohol him or herself."

The above findings are supported in the literature (Klingemann, 2001; Zohhadi, 2006) indicating that the misuse of alcohol usually affects general parenting skills and could result in children experiencing problems at school. It is significant that some participants indicated the danger that children might also start misusing alcohol or other drugs as a result of the father's drinking behaviour.

 

IMPLICATIONS AND CONCLUSIONS

The findings of this study reveal that the alcohol misuse by a father has severe consequences for the family's wellbeing. The couple subsystem is subjected to severe challenges that usually lead to conflict, domestic violence or the breakdown of the relationship. In the parent-child subsystem it was found that children in AUD households are vulnerable to neglect or abuse. Parentification and behavioural problems were noted in the sibling subsystem.

It is suggested that social workers provide the necessary support services to families where the father misuses alcohol. The effect of alcohol misuse on the whole family should not be underestimated and the different subsystems in the family should all be involved in intervention. The need for sustainable prevention services regarding AUD is of high importance in order to decrease the prevalence of alcohol misuse. The need for government to address the substance-abuse problem, utilising different role players such as social workers, health care workers and political and spiritual leaders in South Africa, should also be a high priority.

 

REFERENCES

AMERICAN PSYCHIATRIC ASSOCIATION (APA) 2013. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association.         [ Links ]

BABBIE, E. 2010. The practice of social research (12^th ed). USA: Chapman University: Thomson Wadsworth.         [ Links ]

BRANDELL, J.R. 2011. Theory and practice in clinical social work. New York: Sage Publications.         [ Links ]

BUTCHER, J.N., MINEKA, S. & HOOLEY, J.M. 2010. Abnormal Psychology (14^th ed). Boston: Pearson International Edition.         [ Links ]

CARLSON, D. 1987. Teachers as political actors: from reproductive theory to the crisis of schooling. Harvard Educational Review, 57(3):283-308.         [ Links ]

CHRONISTER, K.M. 2007. Contextualising women domestic violence survivors' economic and emotional dependencies. American Psychologist, 62(7):706-708.         [ Links ]

CLARK, H.W. 2002. Bridging the gap between substance abuse p practice and research: the National Treatment Plan Initiative. Florida: Florida State University College of Criminology and Criminal Justice.         [ Links ]

COYLE, J.P., NOCHAJSKI, T., MAGUIN, E., SAFYER, A., DEWIT, D. & MacDONALD, S. 2009. Journal of family issues: an exploratory study of the nature of family resilience in families affected by parental alcohol abuse. New York: Sage Publications.         [ Links ]

CRANE, C.A., SCHLAUCH, R.C., HAWES, MANDEL S.W. & EASTON, D.L. 2014. Legal factors associated with change in alcohol use and partner violence among offenders. Journal of Substance Abuse Treatment, 47(1):151-159.         [ Links ]

CRESWELL, J.W. 2007. Qualitative research designs. Choosing among five traditions. Thousand Oaks: Sage Publications.         [ Links ]

DAYTON, T. 2012. The set up: living with addiction. New York: Sage Publications.         [ Links ]

DEPARTMENT OF SOCIAL DEVELOPMENT. 2006. Integrated Service Delivery Model: Towards Improved Social Services. Pretoria.         [ Links ]

DE VOS, A., STRYDOM, H., FOUCHÉ, C. & DELPORT, C. 2011. Research at grass roots: for the social science and human service professions (4^th ed). Pretoria: Van Schaik Publishers.         [ Links ]

FISHER, G.L. & HARRISON, T.C. 2013. Substance abuse, information for school counselors, social workers, therapists, and counselors (5^th ed). University of Nevada: Pearson Publishers.         [ Links ]

GOLDENBERG, H. & GOLDENBERG, I. 2002. Counselling today's families.California: Brooks/Cole Publishing Company.         [ Links ]

GUEZ, W. & ALLEN, J. 2000. Module 3: Social Work. UNESCO: Swaziland.         [ Links ]

HOLTMAN, S., SHELMERDINE S., LONDON, L. & FLISHER, A. 2011. Suicide in a poor rural community in the Western Cape, South Africa: Experiences of five suicide attempters and their families. South African Journal of Psychology, 41(3):300-309.         [ Links ]

HOOPER, L.M., DOEHLER, K., JANKOWSKI P.J. & TOMEK, S.E. 2012. Patterns of self-reported alcohol use, depressive symptoms, and body mass index in a family sample: The buffering effects of parentification. The Family Journal: Counseling and Therapy for Couples and Families, 20(2):164-178.         [ Links ]

HUTCHINSON, D.M., MATTICK, R.P., BRAUNSTEIN, D., MALONEY, E. & WILSON, J. 2014. The impact of alcohol use disorder on family life: a review of the empirical literature. Australia: University of New South Wales.         [ Links ]

KAFUKO, A. & BUKULUKI, P. 2008. Qualitative research in Uganda on knowledge, attitudes and practices concerning alcohol. Uganda: University Publishers.         [ Links ]

KLINGEMANN, H. 2001. Alcohol and its social consequences, the forgotten dimensions. World Health Organization. Europe: Regional Office for Europe.         [ Links ]

KLOSTERMAN, M.T. & CHEN, R. 2009. The relationship between relapse to alcohol and relapse to violence. Journal of Family Violence, 24(7):495-505.         [ Links ]

KOOPMAN, F.A., PARRY, C.D.H., MEYERS, B. & REAGON, G. 2008. Addressing alcohol problems in primary care settings: a study of general practitioners in Cape Town, South Africa. Scandinavian Journal of Public Health, 36:392-302.         [ Links ]

McCARTHY, T. & GALVANI, S. 2012. Children, families and alcohol use - essential information for social workers. Birmingham, United Kingdom: A BASW Pocket Guide.         [ Links ]

ROSS, E. & DEVERELL, A. 2004. Psychosocial approaches to health, illness and disability: a reader for health care professionals. Pretoria: Van Schaik Publishers.         [ Links ]

SCHIFF, S.E. 2004. Family systems theory as literary analysis: the case of Philip Roth. USA: University of Florida.         [ Links ]

STEPHENS, P. & SMITH, R.L. 2013. Substance abuse counselling: theory and practice (5^th ed). Essex: Pearson.         [ Links ]

STOVER, C.S., EASTON, C.J. & McMAHON, T.J. 2013. Parenting of men with co-occurring intimate partner violence and substance abuse. Journal of Interpersonal Violence, 28(11):2290-2314.         [ Links ]

STUART, G.L., McGEARY, J.E., SHOREY, R.C., KNOPIK, V.S., BEAUCAGE, K. & TEMPLE, J.R. 2014. Genetic associations with intimate partner violence in a sample of hazardous drinking men in batterer intervention programmes. Violence Against Women, 20(4):385-400.         [ Links ]

WAGMAN, J.A., DONTA, B., RITTER, J., NAIK D.D. & NAIR, S. 2016. Husband's alcohol use, intimate partner violence, and family maltreatment of low-income post-partum women in Mumbai, India. Journal of Interpersonal Violence. doi: 10.1177/0886260515624235.         [ Links ]

WERNER, A. & MALTERUD, K., 2016. Encounters with service professionals experienced by children from families with alcohol problems: a qualitative interview study. Scandinavian Journal of Public Health. doi: 10.1177/1403494816661651.         [ Links ]

ZOHHADI, S. 2006. Problem drinking and fatherhood. the parenting and alcohol project. United Kingdom: University of Bath.         [ Links ]